Firefighters in the United States are at an increased risk for a variety of cancers, as demonstrated by recent epidemiologic studies by the NIOSH. Reduction of cancer risk is an extremely important issue for the fire service, but a number of critical barriers including development of uniform data collection instruments, exposure assessment, better understanding of cancer mechanisms, effective cancer screening and inclusion of potentially vulnerable groups such as women firefighters, must be overcome in order to achieve this goal. The passage of the 2018 Firefighter Cancer Registry Act, to be administered by NIOSH, adds an even more time sensitive need to establishing a coordinated approach to overcoming the critical barriers. We have received notice of partial funding from the Sylvester Comprehensive Cancer Center (SCCC) at the University of Miami to help support a national meeting on cancer research in the fire service, and have also developed the framework for the Fire Fighter Cancer Cohort Study (FFCCS), a multicenter prospective study of cancer in the fire service. We propose to build on this foundation to address the critical barriers to reduction of firefighter cancer risk through completion of the following specific aims: 1) Support implementation of the Firefighter Cancer Registry Act; 2) Establish a unified approach to development of cancer risk surveys and prospective exposure monitoring; 3) Identify putative cellular mechanisms involved in elevated cancer risk in firefighters; 4) Develop a coordinated approach to improving cancer screening in the fire service; and 5) Broad dissemination of symposium findings through stakeholder groups, symposium evaluation and scientific proceedings publication via a dedicated symposium website. These aims will be accomplished through organization of a fire service cancer conference on June 10- 11th, 2019 at the SCCC in Miami. Conference attendees will include members of the FFCCS Oversight and Planning Board, composed of representatives of multiple fire service organizations including labor, administration, NGOs, and other affinity organizations including but not limited to the iWomen, as well as academics with active research addressing firefighter cancer. NIOSH representatives tasked with organization of the Firefighter Cancer Registry will present their development needs to the assembled group, who will develop an action plan to meet these needs. A harmonized firefighter cancer risk survey and approach to development of an exposure matrix and exposure reporting systems will be developed building on the current survey and preliminary exposure matrix used in the FFCCS, as well as the National Fire Operations Reporting System and the Personal Exposure Report used in the state of Florida. Academics with expertise in toxicology and cancer mechanisms will identify potential carcinogenic pathways for further evaluation in the fire service. Academic and fire service experts on cancer screening in the fire service will develop a research and implementation plan to guide future efforts. The proposed conference will result in a roadmap to address cancer prevention research in the fire service, and also support the newly mandated Firefighter Cancer Registry.